Injection of Bone Marrow Aspirate for Glenohumeral Joint Osteoarthritis: A Pilot Randomized Control Trial

Abstract

Purpose: To compare the efficacy of a single, intra-articular, nonconcentrated bone marrow aspirate (BMA) injection in comparison to cortisone for the treatment of glenohumeral joint osteoarthritis (GHJ OA). Methods: Inclusion criteria were patients between the ages of 18 and 75 with a diagnosis of GHJ OA on radiograph. Patients were randomized to receive an ultrasound-guided, intra-articular cortisone injection or BMA injection (without concentration). The primary outcome measure was the Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 12 months. Secondary outcome measures were the QuickDASH, EuroQOL 5-dimensions 5-level questionnaire (EQ-5D-5L) and visual analogue scale. Results: The study included 25 shoulders of 22 patients who completed baseline and 12 months' patient-reported outcome measures (12 shoulders received cortisone, 13 shoulders received BMA) after the study was terminated early by changes in Health Canada regulations. Baseline characteristics demonstrated a significant difference in the ages of the 2 groups, with the BMA group being older (61.6 vs 53.8 mean years, P ¼ 0.021). For the BMA group, a significant improvement was seen in the WOOS index (P ¼ 0.002), the QuickDASH (P < 0.001), and the EQ-5D-5L pain dimension (P ¼ 0.004) between baseline and 12 months. No significant difference was seen for any outcome in the cortisone group between baseline and 12 months. No significant difference was demonstrated between changes in the WOOS scores from baseline to 12 months when compared between groups (P ¼ 0.07). However, a significant difference in changes in scores was seen in the QuickDASH (P ¼ 0.006) and the EQ-5D-5L pain scores (P ¼ 0.003) and the EQ-5D-5L health scores (P ¼ 0.032) in favor of BMA. Conclusions: The results of this study demonstrate that patients with GHJ OA treated with BMA have superior changes in the QuickDASH and EQ-5D-5L pain and health scores but not in the WOOS outcomes measures at 12 months post injection when compared to patients treated with cortisone. However, because of the limited number of patients as a result of the early termination of the study, larger randomized studies are required to confirm these findings. Level of Evidence: Level II, randomized controlled trial.

Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis

“…8 In a pilot clinical trial, individuals with GHOA received either a corticosteroid or an injection of BMA. 40 Results indicated that at the 12-month follow-up, individuals treated with BMA had greater improvements in function and pain, suggesting a superiority of BMA compared to a corticosteroid injection. 40 With regard to adipose-derived orthobiologics, autologous non-digested microfragmented adipose was used to treat patients with GHOA in two cohort studies.…”

“…40 Results indicated that at the 12-month follow-up, individuals treated with BMA had greater improvements in function and pain, suggesting a superiority of BMA compared to a corticosteroid injection. 40 With regard to adipose-derived orthobiologics, autologous non-digested microfragmented adipose was used to treat patients with GHOA in two cohort studies. 23,41 In one study, patients with mild to moderate GHOA received one injection of microfragmented adipose.…”

“…18,38,39 Evidences, albeit limited, from published studies support the use of autologous injectable procedures such as PRP, lipoaspirate, BMA, and BMAC for treatment of GHOA. 8,23,[40][41][42][43][44] With regard to the use of PRP for GHOA, the evidence is limited albeit promising. 8,42,44 In one study, the effect of single injection of leukocyte-poor PRP was compared to hyaluronic acid in the treatment of GHOA with improvements in pain and function identified 1-2 months following the injection.…”

Short-Term Efficacy of Using a Novel Low-Volume Bone Marrow Aspiration Technique to Treat Knee Osteoarthritis: A Retrospective Cohort Study

“…This volume is small enough such that the draw is not diluted with peripheral blood [ 33 , 34 ], but entails a sufficient volume to treat knee OA as has been done in a previous studies [ 30 ]. Previous studies have used between 6 and 20 mls of BMA or BMC [ 13 , 37 ], although previous research using the MC system has found that roughly 10 mls of BMA using this technique is sufficient to achieve positive outcomes [ 30 , 38 ]. To inject the BMA, the patient was placed supine and sterilizing the skin of the knee to be treated was sterilized.…”

“…Previous studies have used between 6 and 20 mls of BMA or BMC [13,37], although previous research using the MC system has found that roughly 10 mls of BMA using this technique is sufficient to achieve positive outcomes [30,38]. To inject the BMA, the patient was placed supine and sterilizing the skin of the knee to be treated was sterilized.…”